Conclusions
Primary care doctors exhibit a notably low sensitivity of approximately 25% when it comes to the crucial task of deciding whether to refer a patient to secondary care. This is especially true in referrals in the field of Dermatology.
On the other hand, they maintain a high specificity rate of 96%, meaning that when they do decide to make a referral, they are highly likely to be correct in their judgment that specialist care is necessary.
This pattern reflects a cautious approach, as primary care physicians seem to prefer minimizing the risk of false negatives, even if it means that some patients who could benefit from secondary care might not be promptly referred. This cautiousness impedes an optimal utilization of specialist resources.
This study reveals that approximately 29% of the referrals involve common and easily diagnosable conditions, even those from teledermatology. About half of them are related to seborrheic keratosis. Another example of conditions that can be confidently identified and managed without referrals includes skin tags, which the device can reliably confirm, and other entities are unlikely to misdiagnose.
The quality of the images significantly influences the performance of the system. This is a well-established fact in the field because image quality not only impacts the effectiveness of algorithms but also hinders dermatologists from making diagnoses through teledermatology systems. Specifically, poor-quality images of nevi often require an in-person consultation, causing unnecessary delays for specialists.
It is typically complex to calculate precise costs, but we can estimate that algorithms like the device could have a substantial impact on cost optimization while simultaneously reducing waiting times and expediting urgent cases.
In terms of the waiting list, the analysis assumes that patients could have received treatment earlier, and the appointment delays were a result of the hospital's waiting list.
The current analysis primarily focuses on malignancy, but there may be other criteria to consider when referring patients. While not addressed in this study, the device incorporates additional algorithms that focus on the severity of chronic skin conditions. Moreover, in certain cases, referrals can be based on the possibility of a specific disease that may be complex to manage.
Summary
- Code: LEGIT.HEALTH_DAO_Derivación_O_2022
- Status: Ongoing
- Start date: April 7th, 2022
- Acceptance criteria:
- Improve the adequacy of referrals to dermatology
- A reduction of waiting lists (at least 30% Warshaw et al. 2011)
- A reduction of the costs in secondary care
